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PubMed2006

Position of the American Dietetic Association: child and adolescent food and nutrition programs.

It is the position of the American Dietetic Association that all children and adolescents, regardless of age, sex, socioeconomic status, racial diversity, ethnic diversity, linguistic diversity, or health status, should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, social, and emotional growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, and nutrition screening and assessment followed by appropriate nutrition intervention and anticipatory guidance to promote optimal nutrition status. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment, and intervention. It is important that continued funding be provided for these programs, which consistently have been shown to have a positive impact on child and adolescent health and well-being. Food and nutrition programs serve as a means to prevent or reduce hunger and food insecurity, but also as a vehicle for nutrition education and promotion of physical activity designed to prevent or reduce overweight and prevent chronic disease. It is the role of the registered dietitian to support adequate and sustained funding for food and nutrition programs, universal health care reimbursement for nutrition services, and the use of research and surveillance programs to evaluate and improve these programs. In addition, the registered dietitian and dietetic technician, registered, are responsible for serving as a nutrition resource to all groups and individuals providing services to children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits.

Adolescent↗
PubMed2006

Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment.

BACKGROUND: Fragility fractures resulting from osteoporosis are common injuries. However, the identification and treatment of osteoporosis in these high-risk patients are widely reported to be inadequate. The goals of this study were to determine how many patients receiving inpatient or outpatient treatment for a fragility fracture could be identified and enrolled in a program for osteoporosis education, investigation, and treatment and receive appropriate osteoporosis care within the program. METHODS: An Osteoporosis Exemplary Care Program was implemented to identify, educate, evaluate, refer, and treat patients considered to be at risk for osteoporosis because of a typical fragility fracture. System modifications included coordination among the orthopaedic unit, Metabolic Bone Disease Clinic, and nuclear medicine unit to provide a continuum of care for these patients. Barriers were addressed through ongoing education of physicians, staff, and patients to increase knowledge and awareness of osteoporosis. The percentages of patients previously diagnosed and treated for osteoporosis, referred for investigation of osteoporosis, treated by the orthopaedic team, and receiving appropriate attention for osteoporosis were calculated. Risk factors for osteoporosis were also assessed. RESULTS: Three hundred and forty-nine patients with a fragility fracture (221 outpatients and 128 inpatients) who met the inclusion criteria and an additional eighty-one patients with a fracture (fifty-five outpatients and twenty-six inpatients) who did not meet the inclusion criteria but were suspected by their orthopaedic surgeons of having underlying osteoporosis were enrolled in the Osteoporosis Exemplary Care Program. More than 96% (414) of these 430 patients received appropriate attention for osteoporosis. Approximately one-third (146) of the 430 patients had been diagnosed and treated for osteoporosis before the time of recruitment. Two hundred and twenty-two of the remaining patients were referred to the Metabolic Bone Disease Clinic or to their family physician for further investigation and treatment for osteoporosis. Treatment was initiated by the orthopaedic team for another twenty-three patients. Many patients had risk factors for osteoporosis in addition to the fragility fracture; these included a previous fracture (forty-nine of 187; 26%), a mother who had had a fragility fracture (forty-two of 188; 22%), or a history of smoking (105 of 188; 56%). CONCLUSIONS: In a coordinated post-fracture osteoporosis education and treatment program directed at patients with a fragility fracture and their caregivers, >95% of patients were appropriately diagnosed, treated, or referred for osteoporosis care. To accomplish this, a dedicated coordinator and the full cooperation of orthopaedic surgeons and residents, orthopaedic technologists, allied health-care professionals (nurses, physical and occupational therapists, and social workers), and administrative staff were required.

Absorptiometry, Photon↗
PubMed1994

Weight perceptions and weight control practices in American Indian and Alaska Native adolescents. A national survey.

OBJECTIVE: To assess weight perceptions and weight control practices among American Indian-Alaska Native adolescents. DESIGN: Survey. SETTING: Nonurban schools from eight Indian Health Service areas. PARTICIPANTS: A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES: A revised version of the Adolescent Health Survey, a comprehensive, anonymous self-report questionnaire with eating- and body image-related questions. RESULTS: Forty-one percent of the adolescent girls reported feeling overweight, 50% were dissatisfied with their weight, and 44% worried about being overweight. Almost half (48%) had been on a weight-loss diet in the past year, with 27% reporting that they had self-induced vomiting at some time to try to lose weight. Eleven percent reported using diet pills. Girls who reported feeling overweight were more likely to engage in unhealthy weight control practices than were those who felt they were of normal weight or underweight. A larger proportion of boys were satisfied with their weight (68%), with 22% worrying about being overweight. However, compared with rural Minnesota youth, both American Indian girls and boys had greater dissatisfaction with body weight. CONCLUSIONS: Our study shows that American Indian youth, particularly girls, are dissatisfied with their weight and are worried about being overweight, and that unhealthy weight control practices are common. More attention needs to be placed on developing culturally appropriate weight management programs for Indian youths.

Adolescent↗
PubMed1985

Preparation and characterization of potential prodrugs of dyphylline.

Four diesters and four monoesters of dyphylline were synthesized as prodrugs proposed to prolong the duration of action of dyphylline. They were characterized by IR, 1H NMR, HPLC, and MS. Appropriate solvent-programming conditions for the HPLC separation of dyphylline and the newly synthesized mono- and diesters were developed. It was confirmed by low-temperature 1H NMR at approximately -40 degrees C that all four monoesters were located on the primary hydroxy position. Attempts to produce the secondary monoesters yielded the primary monoesters during purification. Monoesters were shown by HPLC and MS to migrate between the primary and secondary hydroxy groups in aqueous solution.

Chemistry, Pharmaceutical↗
PubMed1977

Ethical issues in investigation of screening strategies.

Screening programs can be designed to be useful for data collection to study effectiveness of screening. High-risk populations may be identified, and screening techniques applied to a randomly selected subgroup with another subgroup serving as controls. This raises the ethical question of not applying helpful surveillance to individuals known to be at high-risk. Attention should be paid to management of controls, for example, to screen them less frequently, or at least to inform them of their increased risk and advise periodic exams. Against such recommendations is that differences between test and control groups would be minimized and the study less conclusive. Another approach is to use adaptive design, selecting the study group for a large population which is being subject to medical surveillance for some other reason. As in other clinical trails, studies of screening programs must include appropriate surveillance for controls to properly safeguard their rights and medical needs.

Control Groups↗
PubMed2004

A comparative study of knowledge about and attitudes toward the combined oral contraceptives among Korean and Japanese university students.

PURPOSE: To compare university students' knowledge about and attitudes toward the combined oral contraceptives (COC) in two countries with different pharmaceutical systems (Japan and Korea), and to explore the reasons limiting the use of the COC in these populations. METHODS: University students in Korea and Japan completed a questionnaire containing a total of 55 questions about the students' demographics (8 questions), knowledge about the COC (15 questions), attitudes toward the COC (24 questions) and the reasons for limited use of the COC among the population (8 questions). RESULTS: Male students' attitudes toward the COC were significantly more positive than those of female students in Korea, but not in Japan. Knowledge about and attitudes toward the COC did not differ significantly between the two countries. The age at which students desired to use the COC was significantly correlated with age in both countries. There were significant correlations between knowledge about and attitude towards the COC in both countries and between age and attitude towards the COC in Japan. In both countries, the most commonly cited reasons for limited use of the COC were concern about adverse side effects. CONCLUSIONS: These results confirm the need to develop appropriate sex education programs in Korea and Japan. Cultural differences and differences in the pharmaceutical and medical systems between the two countries should be considered when designing sex education programs for young people in Korea and Japan.

Adolescent↗
PubMedDate not supplied

Cigarette smoking in a multiethnic population of youth: methods and baseline findings.

BACKGROUND: To expand upon recent research studies that have identified dramatic ethnic differences in adolescent cigarette smoking, this study was designed to characterize smoking among a multiethnic population of adolescents and to identify significant factors that may protect against smoking initiation. METHODS: During the first 2 years, this mixed cross-sectional, longitudinal study recruited and collected baseline data from a volunteer sample of 1,441 Houston-area public school students in the 5th, 8th, or 12th grade. A wide range of new and established predictors of smoking behavior was assessed, and their associations with ever smoking and susceptibility to smoking were assessed within ethnicity (white, N = 537; African-American, N = 454; and Hispanic, N = 297). RESULTS: Consistent with previous studies, white students smoked in substantially higher proportions than African-American students, with Hispanic adolescents in-between. Simultaneously adjusting for other variables, the odds of ever smoking (OR = 0.47, P < 0.01) and susceptibility to smoking (OR = 0.64, P < 0.01) were significantly lower among African-American adolescents when compared with whites; odds ratios for Hispanics and whites did not differ. Across all three ethnicities, the most important predictor of both ever smoking and susceptibility to smoking was the smoking status of the three best friends. Several ethnicity-specific variables also were identified. CONCLUSIONS: In concordance with previous investigations, cigarette smoking prevalence differs by ethnicity, and the factors associated with ever smoking and susceptibility to smoking differ among white, African-American, and Hispanic adolescents. The results of this study may be used to develop theory-based, culturally appropriate smoking intervention programs for adolescents.

Adolescent↗
PubMed1975

Responses to load disturbances in human shoulder muscles: the hypothesis that one component is a pulse test information signal.

Human motor control has been investigated by applying displacements acting to rotate the shoulder while the subject was endeavouring to maintain a constant position against a pre-existing force delivered by a system of finite stiffness. Four separate stages of the force response were distinguished. First, for the initial 100 msec, an increase in force which was attributed to the viscoelastic properties of activated muscle. Second, after approximately 100 msec, a "medium latency" increase in force accompanied by an increase in EMG activity. Third, a "long latency" increase in force consistent with voluntary action restored the arm to its original position. Fourth, some 500 msec thereafter and dependent upon the final steady force level, a tremor might develop. No changes of force were seen that were of sufficiently short latency to be attributed either to Ia monosynaptic action or immediately following (within 15 msec) polysynaptic action of muscle mechano-receptors. Even the "medium latency" response was too weak to make an appreciable contribution to restoring the arm to its original position; at the best it provided only 15% of the force required. This response is often considered as a "stretch reflex" responsible for maintaining posture in its own right; for example, by means of a servo-assisted transcortical loop (Marsden et al., 1972). Instead, it is now suggested that it might be a test signal designed to inform the central nervous system of the current loading on the muscle and thus permit the CNS to select an appropriate pre-programmed response from its repertoire of motor actions.

Elasticity↗
PubMed1989

Organ procurement in children--surgical, anaesthetic and logistic aspects.

To cover the need in paediatric organ transplantation, every potential donor should be considered as a multi-organ donor. Successful transplantation may be performed with kidneys retrieved from very young infants, even anencephalic neonates if the en-bloc technique using both kidneys is used. Regarding the liver, paediatric donors can be accepted from one month of age while livers harvested from older children and even young adults can be transplanted into small children after ex-vivo reduction of the size of the graft. Multi-organ procurement from the same donor provides valuable organs if the anaesthetic management of the donor is appropriate. Active transplant programs needs international cooperation which is made possible by the organ exchange organizations.

Adolescent↗
PubMed1987

Spatial role-taking ability among bilingual and monolingual kindergarten children.

Fifty-seven children enrolled in a bilingual Spanish kindergarten program, assigned to appropriate language and age-related groups, were shown a graduated sequence of increasingly complex arrangements of multicolored blocks and were asked to judge how the original arrangement would look from the opposite and the side perspectives. A series of 2(younger vs. older) X 3(Spanish Monolingual vs. English Monolingual vs. Spanish-English Bilingual) ANOVAs for each of the types of responses (correct, incorrect, egocentric) showed a significant main effect for age on the incorrect answers. No differences associated with egocentrism were obtained. There was no relationship between age and success with simple and complex spatial tasks. As opposed to other studies that suggest certain cognitive advantages for young bilingual children, this study indicates no perceptible differences associated with being monolingual or bilingual at the ages of 5 and 6 for spatial tasks.

Child↗
PubMed1992

Rehabilitation of patients with thoracic outlet syndrome.

A series of physical therapy protocols is proposed for patients with thoracic outlet syndrome. The anatomic findings dictating certain physical therapeutic approaches are outlined. General principles of physical therapy that stem from these findings are suggested, and a specific protocol for the physical therapy regimen is given. An appropriate physical therapy program for thoracic outlet syndrome patients with symptoms of mild-to-moderate severity can avoid early surgery. Degradation of symptoms or invalidating functional compromise indicates a referral to surgery. Physical therapy cannot replace surgery in severe or complicated forms of thoracic outlet syndrome with vascular or neurologic compromise.

Humans↗
PubMed1988

Composition of mixed octadecadienoates via ozonolysis, chromatography and computer solution of linear equations.

An approach to the analysis of 55 possible nonconjugated positional isomers of octadecadienoic acid is described and tested with mixtures of individual synthetic methyl esters. In the first example, by ozonolysis a seven-component mixture consisting of cis,cis 5,12-, 6,10-, 6,11-, 6,12-, 7,12-, 8,12-, and 9,12-octadecadienoates was converted to aldehydes, aldehyde-esters and dialdehydes. These fragments were separated on a 50 m X 0.2 mm free fatty acid phase (FFAP) vitreous silica capillary column. Equations for an arbitrarily restricted 12 X 15 matrix of linear simultaneous equations and a computer solution of the matrix provided the composition of the initial methyl octadecadienoate mixture. The power and significance of this method became apparent with the observation that only two of the seven isomers in the known mixture were resolved as single peaks by state-of-the-art capillary gas chromatography, but all seven were identified and estimated with acceptable error by the ozonolysis-capillary gas chromatography-computer procedure. In a generalized approach to the analysis of the 55 possible nonconjugated isomers, a computer program selects the appropriate matrix of linear simultaneous equations based on the aldehyde data supplied by the analyst. Twenty of 21 combinations of seven isomeric esters taken five at a time have been analyzed to assess the efficiency of the method. To illustrate applicability at this stage of development, the method has been used to analyze the diene products of the hydrazine reduction of gamma-linolenic acid and the diene products from the biological desaturation of isomeric monoenes.(ABSTRACT TRUNCATED AT 250 WORDS)

Chromatography, Gas↗
PubMed2002

[Prevention and complementary medicine in aging].

The subsequent brief review is based on a systematic literature search (Medline, http://www.lef.org and books under the topic Antiaging from 2001). Among the preventive and complementary measures against aging, caloric restriction with an adequate diet is in first place. If the energy supply is reduced by 17%, cardiovascular mortality drops to 31-41%. Among the mechanisms of aging, impaired formation of reactive oxygen species (oxidative stress) plays an important role. Moreover, antioxidants (vitamins A and B as well as selenium) provide protection. If obesity is complicated by a metabolic syndrome, a formula diet should be employed under the supervision of the urologist. The hormonal changes involved in the male climacteric should be treated by hormone replacement therapy. Testosterone given as a gel, plaster, or injection compensates for the secondary hypogonadism and treats osteoporosis. The muscle function can be improved by physical activity only. Sexual dysfunction, however, is not corrected with androgen hormone replacement therapy, whereas an appropriate physical training program may even improve potency by inducing a reactive penile hyperemia. In his office the urologist may implement a program specifically for the "aging male." If he diagnoses a metabolic syndrome, effective countermeasures are required to prevent early onset of arteriosclerosis.

Aged↗
PubMed2003

[Follow-up treatment with physiotherapy after arthroscopic reconstruction in SLAP lesions].

An appropriate physiotherapeutic treatment program complements an optimal operative result. In the instance of SLAP lesions, a differentiated therapy is only possible on consultation with the surgeon. A detailed treatment design allows optimal guidance of the patient to his or her personal goal. Important treatment elements include the optimization of the ability of the humerus head to centralize and the proprioception of the shoulder joint, as well as reinstatement of strength and endurance, especially of the rotator cuff.

Aftercare↗
PubMed2001

Chemical modifiers for direct determination of cobalt in coal combustion residues by ultrasonic slurry-sampling-ETAAS.

Five modifiers were tested for the direct determination of cobalt in coal fly ash and slag by ultrasonic slurry-sampling electrothermal atomic absorption spectrometry (USS-ETAAS). The furnace temperature programs and the appropriate amount for each modifier were optimized to get the highest signal and the best separation between the atomic and background signals. Nitric acid (0.5% v/v) was the most adequate chemical modifier for cobalt determination, selecting 1,450 degrees C and 2,100 degrees C as pyrolysis and atomization temperatures, respectively. This modifier also acts as liquid medium for the slurry simplifying the procedure. The remaining modifiers enhanced the background signal, totally overlapped with cobalt peak. The method optimized gave a limit of detection of 0.36 microg g(-1), a characteristic mass of 13 +/- 1 pg and an overall-method precision which is highly satisfactory (<7%, RSD). The method was validated by analyzing two certified coal fly ash materials, and satisfactory recoveries were obtained (83-90%) and no statistical differences were observed between the experimental and the certified cobalt concentrations. Additionally, certified sediment, soil and urban particulate matter were assayed; again good results were obtained. The developed methodology was used to determine cobalt in several coal combustion residues from five Spanish power plants.

Calibration↗
PubMed2005

Needs assessment of rural communities: a focus on older adults.

High-quality community needs assessments can help focus limited resources on the needs of a rapidly expanding population-older Americans. Based on such assessments, organizations and communities can effectively plan and deliver cost-effective, appropriate health promotion/wellness programs and health/social services to targeted populations. This article, which describes the Arkansas Aging Initiative's (AAI) use of a community needs assessment to identify its constituents' top health needs, provides specific background information for communities with demographics similar to those in Arkansas and offers assessment strategies for communities throughout the US. The AAI used two complementary methodologies to obtain critical input from Arkansas providers and their communities: focus groups of healthcare providers and community members and surveys administered to older adults. The assessment confirmed that health problems in the communities were consistent with leading causes of morbidity and mortality at state and national levels. It indicated that respondents' top three health needs related to affordability, including affordability of prescription medications, medical care, and health insurance, and that needs varied inversely with age. In other findings, married individuals rated their own health as better than their single counterparts; whites rated their health better than non-whites; and more than half of respondents reported leaving their counties to receive healthcare. This community needs assessment has enabled the AAI to address respondents' needs by developing specific educational and interdisciplinary healthcare initiatives, such as increasing access to a prescription drug assistance program.

Aged↗
PubMed1986

Education of the patient with cardiac disease in the twenty-first century: an overview.

The current status of education, behavioral change, and use of technology identifies a need for professionals who can develop interactive educational programs and apply existing techniques in a cost-effective manner. The general public, including patients with cardiac disease, are sophisticated consumers of information technology and demand quality production. The challenge is to train specialists to produce educational programs, to instruct health professionals in use of these programs, to deliver appropriate messages, to teach needed skills to patients with cardiac disease, and to evaluate the outcomes. Unless incentives to restore cardiac patients to an optimal functional status with few recurrences and complications are as tangible as are incentives for treating acute cardiac illnesses, the appropriate use of technology to educate patients with heart disease is unlikely to develop. However, the trend to increased ambulatory care under prospective payment systems makes it likely that technology will be applied to improve the efficiency in maintaining health and preventing acute illness. The potential benefits to the nation are substantial.

Attitude to Health↗
PubMed1994

Psychopathology and the rehabilitation of patients with chronic low back pain disability.

Recent research has clearly demonstrated the important role that psychopathology and other psychosocial factors can play in chronic low back pain disability (CLBPD). The purpose of this study was to evaluate whether diagnosed psychopathology is a significant limiting factor in the successful rehabilitation of patients with CLBPD. One hundred fifty-two CLBPD patients (97 men, 55 women) were given a structured psychiatric interview for official DSM-III-R diagnosis of psychopathology upon entering an intensive 3-week functional restoration treatment program. All patients were assessed for the presence of Axis I clinical disorders and Axis II personality disorders. They were subsequently tracked for 1 year after program completion, with treatment outcome being defined as return-to-work status at this 1-year time period. Results demonstrated that, though more than 90% of patients obtained at least one Axis I diagnosis, and more than 50% obtained at least one Axis II diagnosis, neither type nor degree of psychopathology were significantly predictive of a patient's ability to successfully return to work. These prospective study results suggest that if a treatment program is structured to appropriately manage psychopathology, as is the case of an intensive functional restoration program, then psychopathology does not have to interfere with successful treatment outcome.

Adult↗